I am Campaigns and Networking Coordinator at Baby Milk Action, which monitors the baby food industry. Our aim is to protect breastfeeding and babies fed on formula from practices that put profits before health. This is a daily look behind the scenes of the work of Baby Milk Action, including the boycott of Nestlé (the worst of the baby food companies), which we promote in the UK. See the Baby Milk Action website if you are unfamiliar with our work.

Monday, May 21, 2007

Exposing Nestlé malpractice on its doorstep

I hope to have a film clip available before too long about the event. The aim was to raise awareness of the practices Nestlé continues to use in attempts at undermining breastfeeding and increasing sales of breastmilk substitutes. It is Nestlé’s stated aim to grow its infant nutrition business year-on-year – though it does claim that it promotes breastfeeding in the process.

Monitoring by the International Baby Food Action Network (IBFAN) shows otherwise and our evidence was substantiated last week by the publication of two independent investigations.

We did a stunt at the demonstration showing how the techniques used by Nestlé and other companies work. More about that in a second.

Firstly, I just want to thank everyone who has been sending on my email alert about the Bangladesh and Philippines reports. I see there are several bulletin boards generating significant traffic to this blog and new sign-ups to our petition of solidarity are flooding in. I’ll quote some of the messages of support at the end of this message. In particular I see there is a campaign being promoted by members of Mumsnet, supported both by mothers who breastfed and bottle fed, as the campaign should be.

(Mumsnet is not to be confused with Nestlé-sponsored Netmums. Hopefully members of Netmums will also view the film and give their support to mothers in the Philippines, despite the Nestlé sponsorship – I see someone posted the link to the films on the long-running thread there on Saturday. This shows how boycotting Nescafé works to raise awareness of Nestlé malpractice as well as keep up pressure on the worst of the baby food companies).

The marketing requirements introduced by the World Health Assembly, which are the standards we monitor companies against, exist to protect all mothers and infants. They aim to stop breastfeeding being undermined AND to ensure breastmilk substitutes are used safely, if necessary. In the Philippines 16,000 infants die every year due to inappropriate feeding, according to the World Health Organisation, which is why the Ministry of Health introduced new marketing regulations. These are being challenged in the courts by pharmaceutical companies.

Nestlé is not part of that legal challenge and claims to support the new regulations, though in reality it has challenged aspects of them and continues to violate the existing weaker measures. Nestlé has also written to some key policy makers attacking Baby Milk Action’s campaign of solidarity with the Philippines. I did ask Nestlé’s Head of Corporate Affairs to leave a copy of its letter at reception for me to collect on Saturday as I was not copied in on it, despite it being a response to a letter I had sent to Nestlé after the company first wrote to me. Unfortunately there was no sign of the letter and no message from the Head of Corporate Affairs. See:http://boycottnestle.blogspot.com/2007/05/demonstration-tomorrow-at-nestl-uk-hq.html

As well as setting up our displays and leafleting passers by, we did our stunt, showing the practices Nestlé uses in the Philippines and elsewhere.

Materials used were Nestlé originals and all the techniques have been substantiated. First up was a Nestlé Medical Delegate (played by me) entering the office of a doctor (a volunteer from the crowd). Medical Delegates try to ingratiate themselves with doctors by keeping record cards with details such as their birthdays and details of their spouses and children. They have offered air conditioners, which are expensive items and obviously much sought after in countries such as the Philippines. Doctors are offered air tickets to seminars in expensive hotels, where sight seeing and dinners sometimes appear as much as a draw as any speakers that may have been arranged. Other health workers receive lesser gifts, such as food packs and other items (these techniques were also exposed by Syed Aamar Raza, Nestlé whistle blower from Pakistan – see:http://www.babymilkaction.org/update/update27feature.html)

In its attack on our campaign of solidarity with the Philippines, Nestlé suggested we were wrong to criticise it for such activities. It has since emerged, however, that is not only Baby Milk Action that finds Nestlé is violating the marketing requirements. The Bureau of Food and Drugs in the Philippines has told Nestlé that items such as umbrellas, which the company claims are ‘cheap’ and ‘of professional utility’, are not permitted under existing regulations. They are seen as inducements.

Nestlé and other companies promote formula to health workers and mothers with misleading claims. This is shown graphically in the UNICEF film. Some mothers believe that formula will make their children more intelligent as a result of this promotion.

In our role play I presented the doctor with Nestlé Nestogen infant formula. Nestlé undermines the 'breast is best' message required by the regulations by promoting it as containing DHA, which it calls‘Brain Building Blocks’. It states on the label: “"DHA - Experts recognize DHA as essential for brain development and good vision."

Nestlé's Nan HA 2 formula in the Philippines claims: "Nan HA 2 provides your baby with all nutrients esential for optimal physical and mental development. Thanks to Protect Plus (TM), a unique combination of protective ingredients, it also helps to modulate your baby's natural immune defenses and to reduce the risk of allergy in the critical period of weaning."

In Bangladesh, The Guardian, found promotional fliers for Nestlé Lactogen infant formula distributed widely to doctors for handing on to mothers. Nestlé claimed these are for use only after formula has been prescribed, despite the fact that the Code does not permit such items.

In the Philippines film, several mothers interviewed say they were advised to artificially-feed by their doctors.

The promotional methods lead to doctors promoting formula rather than helping mothers to overcome any problems they may experience with breastfeeding. As the promotion suggests formula is nearly as good as, or even better, than breastfeeding, it is seen as making little difference to the health outcomes for the infants whatever feeding method is used.

The differences are apparent in all countries from epidemiological research. But where there is not access to health care the shortcomings of formula are much starker and costs lives. Here is a section of the Guardian article, which you can find in its entirety at:http://www.guardian.co.uk/medicine/story/0,,2079757,00.html

-----Quote beginsEti Khuman's face lies cradled on her mother's shoulder, her cheek resting in against Mina's collarbone. Eti is beautiful, but she is poorly: her breathing is heavy, and Mina has the distracted look of a mother who is very worried indeed. Eti's illness - first vomiting, then diarrhoea - struck without warning. Like all mothers in Bangladesh, Mina knew to fear diarrhoea: in this country, diarrhoea can kill. So she wasted no time in bringing her eight-week-old daughter here, to the main diarrhoea hospital near her home in the capital, Dhaka.

Eti was admitted, and now she and Mina are in the main ward, a sweltering room so packed with beds that there is barely space to walk between them. It's a general ward, but most of the patients are babies. Some, like Eti, are being held by their mothers: others lie quietly on their beds attached to drips. Not one is crying: they are all much too weak for that.

Twenty-five years ago, when Dr Iqbal Kabir first came to work at this hospital, small babies were almost unknown as patients. Today, he says, infants make up as many as 70% of admissions.

The reason? Kabir shakes his head, and points to a poster on the wall above Eti's bed. The same poster is displayed, many times, around the ward. It shows a baby's bottle, with a big cross drawn heavily through it. The message is clear. "Bottlefeeding is harmful," says Kabir. "Because bottlefed babies get diarrhoea, since their formula is mixed with dirty water and since their bottles are not sterile. Do you know how many breastfed babies are admitted here with diarrhoea? The number is almost zero."

Eti has been bottlefed almost since birth: Mina says she wanted to breastfeed, but when she had difficulties there was no one to give advice or support. Mina's story was typical of those of many of the mothers I met in Bangladesh: when she hit problems and went to a doctor, the suggestion was to try formula. In doctors' surgeries and pharmacies across the country, it seems, health professionals are quick - far too quick, say breastfeeding campaigners - to suggest bottlefeeding as the way forward.----quote ends

Health workers should also meet their obligations under the marketing requirements and should provide the support mothers need. IBFAN groups try to provide training on the marketing requirements (just as I did last Monday in Cardiff). UNICEF's Baby Friendly initiative is helping to change hospital practices so mothers are better supported. And mother support groups help mothers to help each other. But there needs to be far much of all of this. Which is partly a question of funding, but also political will, both for governments and professional associations. At the same time, it is essential the promotion and the bribary stops.

With medical help, infants who have suffered diarrhoea and become malnourished can recover, though may suffer longer-term impact. With help, mothers who have been persuaded to introduce feeding bottles can relactate. The doctor in The Guardian article says as many as 70% of mothers are able to begin breastfeeding again if given support and advice.

It is not just a question of lack of access to health care that leads to infants dying if they are not breastfed – and in Bangladesh 314 infants could be saved every day if breastfeeding rates improved, according to Save the Children.

There is the expense of the formula. In our second role play I pretended to sell a volunteer mother from the crowd a tin of Nestlé Nan for £50. The two tins for the week would cost £100, or about half the minimum wage in the UK. That is the reality for poor mothers who formula-feed in many countries – half the family income may go on formula. If you are in the UK, imagine being on the minimum wage and having to pay out £100 per week for a product that increases the chances of your child becoming sick. Sometimes mothers over-dilute the formula to make it last longer. Other family members may miss out on essentials as parents try to meet the cost.

The label on the tin used in the role play was in Russian – which fortunately my volunteer did not understand – to illustrate the point that still labels are sometimes in the wrong language (though with Nestlé this has much improved thanks to the boycott campaign as in 2000 the Chief Executive said labels would be translated – 19 years after this became a requirement). See:http://boycottnestle.blogspot.com/2007/01/30th-anniversary-year.html

At the same time, some mothers will be illiterate and dependent on the images on the labels.

The mother could see she needed water. So I handed her a bucket and directed her to the river, two miles away.

---Quote from UNDP report beginsThe problem is that sludge treatment and disposal facilities are rare. The result: indiscriminate disposal of inadequately treated effluents into the Pasig River - a complex network of waterways that links the Laguna de Bay Lake to Manila Bay through a huge urban conurbation. Another 35 tons of solid domestic waste is deposited in the Pasig annually by squatters dwelling in makeshift settlements on the river's banks. In total, some 10 million people discharge untreated waste into the river. This has serious consequences for public health. The Pasig is one of the world's most polluted rivers, with human waste accounting for 70% of the pollution load. Faecal coliform levels exceed standards set by the Department of the Environment and Natural resources by several orders of magnitude - and around one-third of all illness in Manila is water related. The 4.4 million people living along the river face particularly acute problems, especially during the floods in the June to October rainy season. During the low flow season the Pasig River reverses direction and carries pollution into Laguna Lake, creating further public health problems.---quote ends

Hopefully mothers will understand the importance of boiling water or understand this from the label. So my volunteer was asked to fetch some firewood. As there were no trees we could chop nearby, I sold her some for £10, a rough adjustment to UK prices.

We set up the little fire and while pretending to wait for the water to boil, I gave her some of the presents Nestlé distributes to mothers around the world, including a little flag for her child and a baby-gro with the words “I love my Nestlé mum”. She was also invited to join a Nestlé baby club for further information and offers from the company.

I assembled the bottle – which like many bottles, looked like a toy, covered in cartoon characters. Nestlé doesn’t make bottles – we hold other companies to account for this. I handed the bottle to the mother, wishing her luck and pointing out that if her child did become sick, it had nothing to do with me. It was her fault.

So we tried to bring to Nestlé’s doorstep the reality of what it is doing around the world to push its products and its impact.

For a more realistic view, watch the UNICEF film. We are taking orders for this on DVD, which we hope to be able to send out fairly soon. See our on-line Virtual Shop. While you are there, please take a look around. We rely on membership fees, donations and merchandise sales to keep operating.

We ended our demonstration with a message of support to mothers and campaigners in the Philippines from those present. I hope to be able to post the clip soon.

Here are some of the messages of support that have come in with the latest petition sign ups since we posted links to the UNICEF film:

Jane, UK: “These women and their babies deserve to know that breastfeeding is the best thing for their babies. They are being misled for profit, and their babies being put fatally at risk for money and that is something that needs to be stopped.”

Roslyn, Scotland: “Hopefully one day the international community will stop standing up for business and instead recognise the 'little people'. Until then, we will keep fighting!”

Pauline, England: “Best wishes and good luck from England.”

Clair, Wales: “Well done for getting together to fight for the things you believe in; many of us could learn from you. Best wishes with your campaign.”

Stephanie, UK: “Breastfeeding is best for babies, their mothers and the wider society they live in. It doesn't matter what marketing campaigns say no artificial "milk" can be as good as breastmilk. Your babies will be happier and healthier if they are breastfed - and there are wider positive economic implications to breastfeeding.”

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